Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Major Depressive Disorder and Generalized Anxiety Disorder

The patient is melodramatic and flighty. The patient is not malingering, not consciously attempting to deceive. Years ago, this was referred to as the revealing-concealing hysteric. They are shallow and attention seeking. They need to be the center of attention, and they are often seductive with rapidly shifting superficial emotional expression. They make those who are attempting to assist them very uncomfortable.

They are excessively emotional, and you will often feel that they are seductive and inappropriately affectionate. This seductive behavior is often inappropriate to the context and can be displayed in doctor’s offices, in physical therapy and in the workplace. You find them initially charming and open, but their need to be in emotional command of the situation will quickly be wearing. You will be uncomfortable with their seemingly excessive flattery and/or need to bring gifts or other signs of “just too much” affection.

They will be very dramatic in their presentation of psychological and physical symptoms. Their symptoms seem theatrical, and their attachment to you and others is superficial and rapidly shifting and shallow. They may seem concerned about impressing you and attempt to extract from you compliments on how they look and how well they are dealing with the discomfort from their injuries.

You may feel embarrassed with the degree of their emotionality, but realize, they are not at all embarrassed. You will note that these emotions have no depth even though they are extreme. They may engage in elaborate explanations of their emotions, but you will note an absence of insight. They simply are unaware or unconcerned with the impact that they are having upon you or others.

More troubling is that they are very suggestible and even the slightest reference to what their symptoms could mean, even if this suggestion is provided by another patient, immediately leads to excessive alarm and even more drama. Sobbing, laughing too quickly and too loudly and other attempts to hold them as the focus of everyone’s attention will eat up your time and patience.

These are histrionic personalities, and they may account for as many as 10-15% of those in psychological care and likely 5+% of those in the health care delivery system since physical complaints become a welcome environment for their unbridled emotionality.

You cannot reassure, dissuade or otherwise alter their behavior. You can best contain the behavior by making interactions brief, follow an agenda and be based upon exchange of data, not responding to the excessive emotionality.